Provider Demographics
NPI:1922015973
Name:LEE, MICHELE YEETING (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:YEETING
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:350 PONCA PL
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-3828
Mailing Address - Country:US
Mailing Address - Phone:303-938-1110
Mailing Address - Fax:303-938-1145
Practice Address - Street 1:350 PONCA PL
Practice Address - Street 2:SUITE 250
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-3828
Practice Address - Country:US
Practice Address - Phone:303-938-1110
Practice Address - Fax:303-938-1145
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM99-243207QG0300X
CODR-47318207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66570361Medicaid
COCOA104705Medicare PIN
COH63316Medicare UPIN